Intravenous iron replacement

LMW iron dextran — LMW ID (INFeD, CosmoFer) is the least expensive of the IV iron formulations that can be administered in a single, large dose (total dose infusion).

LMW ID can be given as multiple doses of 2 mL (equivalent to 100 mg elemental iron, based on a concentration of 50 mg elemental iron per mL). LMW ID can also be given as a single, total dose infusion.  We often give a total dose infusion of 1000 mg in 250 mL of normal saline over one hour.  Although this is not a US Food and Drug Administration-approved dosing, doctors have not observed any serious adverse events with this approach in 1000’s of administrations.

A test dose is required prior to the first dose of LMW ID (0.5 mL [25 mg]).  This may be given gradually over at least 30 seconds; we prefer to administer the test dose over five minutes while observing the patient.  If no symptoms occur during the first 5 to 10 minutes, it is extremely unlikely that an infusion reaction will occur.  After the test dose, we administer the remainder of a 1000 mg dose over the balance of one hour.

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